| 李忠伟,任鹏,张树文,等.组合式外固定架辅助显微外科技术治疗开放性胫腓骨远端骨折合并软组织缺损.骨科,2018,9(2): 112-117. |
| 组合式外固定架辅助显微外科技术治疗开放性胫腓骨远端骨折合并软组织缺损 |
| The clinical efficacy of hybrid external fixation assisted with microsurgery in the treatment of distal tibiofibular fractures with soft tissue defect |
| 投稿时间：2017-06-21 |
| DOI：10.3969/j.issn.1674-8573.2018.02.006 |
| 中文关键词: 胫骨 腓骨 骨折 外固定器 |
| 英文关键词: Tibia Fibula Fractures, bone External fixators |
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| 中文摘要: |
| 目的 探讨组合式外固定架辅助显微外科技术治疗开放性胫腓骨远端骨折合并软组织缺损的临床疗效。方法 回顾性分析2010年12月至2014年11月我科采用组合式外固定架辅助显微外科技术治疗的49例开放性胫腓骨远端骨折合并软组织缺损病人的临床资料。其中，男31例，女18例；年龄为16~60岁，平均35.3岁。根据Gustilo分型：Ⅱ型8例，Ⅲa型9例，Ⅲb型31例，Ⅲc型1例。软组织缺损面积为3 cm×5 cm~5 cm×10 cm。术后根据Maryland评分标准评定疗效。结果 病人术后均获得12~18个月随访，平均13.5个月。末次随访时，骨折均愈合，其中1例钉道感染，予以清创后换药愈合。术后去除外固定架时间为3~6个月，其中2例因外固定架携带困难于术后3个月拆除，其余病人以骨质愈合为标准拆除外固定架。末次随访所有软组织缺损均愈合。软组织缺损采用植皮治疗39例，其中2例局部斑片状坏死经再次植皮后愈合，1例皮下积液经换药痂下愈合；穿支皮瓣10例，其中1例转移皮瓣皮缘坏死经植皮后愈合。术后12个月根据Maryland评分评定踝关节功能：优8例，良32例，可9例，优良率为81.6%。结论 在开放性胫腓骨远端骨折合并软组织缺损治疗中，组合式外固定架辅助显微外科技术能有效地固定骨折、保护并高效修复受损软组织，减少并发症发生。 |
| 英文摘要: |
| Objective To explore the clinical efficacy of a hybrid external fixation assisted with microsurgery in the treatment of the distal open tibiofibula fracture with soft tissue defect. Methods Between December 2010 and November 2014, 49 patients with distal open tibiofibula fracture combined with soft tissue defect were managed with the hybrid external fixator and microsurgery. There were 31 men and 18 women, with an average age of 35.3 years (range from 16 to 60 years). According to Gustilo classification, there were 8 cases of type Ⅱ, 9 cases of type Ⅲa, 31 cases of type Ⅲb, and 1 case of type Ⅲc, with the soft tissue defect in the area of about 3 cm×5 cm-5 cm×10 cm. All patients were evaluated by the Maryland Scale system at the final follow-up. Results The 49 patients were followed up for 12 to 18 months (average 13.5 months). All cases achieved normal fracture union. One patient suffered pin track infection, which was cured by dressing changes. The average time of external fixation was 3-6 months. One patient who had the difficult carrying the external fixation underwent the removal of the external fixation after 3 months, and the external fixations in the rest were removed after the fracture healing. At the final follow-up, all the soft tissue defects healed. Thirty-nine cases were managed with skin grafting surgery, of which, 2 cases suffered patchy necrosis that was cured by the skin graft again, and one case with the subcutaneous dropsy was healed by dressing changes. Nine cases were treated with perforator flap, of which, one suffered skin edge necrosis cured by the skin graft. After 12 months, according to the Maryland system, the ankle function was excellent in 8 cases, good in 32, fair in 9, with an excellent and good rate being 81.6%. Conclusion Hybrid external fixation combined with microsurgery is effective in the treatment of the open distal tibiofibula fracture with soft tissue defect, because it can protect the skin and accelerate the repair of the soft tissue injury with the low complication. |
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